Wave after wave of Medicaid supporters made their way to the testimony table at Thursday’s hearing on expansion of the health insurance program for the poor. Their plugs for Sen. Irene Aguilar’s bill were emotional, statistical, philosophical and fiscal.

What there was not was any vocal opposition from the public. Republican senators on Aguilar’s Health and Human Services Committee voiced their opposition in comments and questions, getting on the record their pointed concerns about soaring health costs and government assumptions of social welfare responsibility. But the populist voices did not follow with attempts to block S.B. 200, which would put into law Gov. John Hickenlooper’s desire to accept 100 percent federal funding of an expanded Medicaid program.

We only briefed the story in today’s paper, because the outcome appears to be a foregone conclusion, and the most dramatic moment in the debate was in December when it was not clear what Hickenlooper would do. Democrats who favor health care reform control the legislative committees hearing the Medicaid bill, and it is likely to get Hickenlooper’s signature this spring.

That said, supporters and opponents framed some new arguments about Medicaid expansion, which will add between 100,000 and 150,000 people in Colorado to public insurance.

While introducing her own bill, Denver Democrat Aguilar said 16 percent of Coloradans are currently without health insurance, and nearly 60 percent of the uninsured have jobs. Many of those with jobs had access to an employer-sponsored plan, but couldn’t afford the high premiums, she said. Expanding Medicaid to cover more of the working poor and working middle class would fill that gap, she argued.

Sen. Kevin Lundberg, a Berthoud Republican, brought up long term budget arguments that Democrats have not spent a lot of time addressing in health care reform. What’s the plan

if Congress “gets serious” on spending, and decides not to indefinitely fund a Medicaid expansion that, at a 100 percent federal pickup, will be a major driver of future budget increases, he asked? Lundberg said supporters’ attitudes appear to be, hey, the money looks “free” now, so “let’s run with it.”

Aguilar responded in two ways. People need health care, she said, and if they don’t get it with decent insurance, they will get it the more expensive and less medically sound way, in the emergency room. The public will pay for it either way. But she also said out loud something many Democrats have thought privately — yes, the new Medicaid money might not last forever. But even in the short term, she said, adding tens of thousands of people to a good insurance plan is good for the state. If the worst happens with future budget negotiations, and the state finds its 10 percent share after 2017 to be a burden, Colorado may have to “reassess,” Aguilar said. “It’s a good investment right now,” she said.

Republican Sen. Ellen Roberts of Durango wanted to know more about claims that new managed care programs in Medicaid will bring down costs in the long run. Those are worthy questions as well, since the savings Colorado has claimed so far from new managed care are not quite as impressive when the added costs of those programs are taken into account. Colorado has said a program putting hundreds of thousands of Medicaid patients into medical management plans cut $20 million from what would have been spent on health care for those patients under standards Medicaid. But those new management programs cost the state $17 million to provide, meaning a net savings of about $3 million the first year. Colorado claims those savings will scale up as more and more Medicaid patients are added to management plans, but few other states have practical results to prove it.

Roberts also wanted to know who would be caring for all the new Medicaid expansion patients, when there are frequent reports of existing Medicaid clients having a hard time finding doctors or dentists who will accept state rates.

Midway through the long supportive testimony, Elisabeth Arenales of the Colorado Center on Law & Policy framed the pro-Medicaid votes in lay terms everybody could understand. It’s not just that the feds will pay 100 percent of the new costs for newly qualifying patients. The Affordable Care Act also said the 100 percent match would apply to some existing Colorado Medicaid clients up to 100 percent of the federal poverty level, who were able to sign up because of the 2009 state fee imposed on hospital providers. Previously those clients were getting only the 50/50 Medicaid match from federal spending. The act also shifts other state costs to the federal 100 percent plan, including some prison health costs. Arenales called it a “refinancing” that Colorado shouldn’t pass up.